Screening for Hearing Loss in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

• Published in: JAMA : the journal of the American Medical Association 2021-03, Vol.325 (12), p.1202-1215
• Main Authors: Feltner, Cynthia, Wallace, Ina F, Kistler, Christine E, Coker-Schwimmer, Manny, Jonas, Daniel E
• Format: Article
• Language: English
• Subjects: Accuracy; Adults; Aged; Evaluation; Hearing Aids; Hearing loss; Hearing Loss - diagnosis; Hearing Loss - rehabilitation; Hearing Loss, Sensorineural - diagnosis; Hearing Tests; Humans; Mass Screening - adverse effects; Mass Screening - methods; Meta-analysis; Middle Aged; Older people; Practice Guidelines as Topic; Quality of Life; Reviews; Risk Assessment; Screening; Sensitivity; Sensitivity and Specificity; Systematic review; Task forces
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2020.24855

IMPORTANCE: Hearing loss is common in older adults and associated with adverse health and social outcomes. OBJECTIVE: To update the evidence review on screening for hearing loss in adults 50 years or older to inform the US Preventive Services Task Force. DATA SOURCES: MEDLINE, Cochrane Library, EMBASE, and trial registries through January 17, 2020; references; and experts; literature surveillance through October 8, 2020. STUDY SELECTION: English-language studies of accuracy, screening, and interventions for screen-detected or newly detected hearing loss. DATA EXTRACTION AND SYNTHESIS: Dual review of abstracts, full-text articles, and study quality. Meta-analysis of screening test accuracy studies. MAIN OUTCOMES AND MEASURES: Quality of life and function, other health and social outcomes, test accuracy, and harms. RESULTS: Forty-one studies (N = 26 386) were included, 18 of which were new since the previous review. One trial enrolling US veterans (n = 2305) assessed the benefits of screening; there was no significant difference in the proportion of participants experiencing a minimum clinically important difference in hearing-related function at 1 year (36%-40% in the screened groups vs 36% in the nonscreened group). Thirty-four studies (n = 23 228) evaluated test accuracy. For detecting mild hearing loss (>20-25 dB), single-question screening had a pooled sensitivity of 66% (95% CI, 58%-73%) and a pooled specificity of 76% (95% CI, 68%-83%) (10 studies, n = 12 637); for detecting moderate hearing loss (>35-40 dB), pooled sensitivity was 80% (95% CI, 68%-88%) and pooled specificity was 74% (95% CI, 59%-85%) (6 studies, n = 8774). In 5 studies (n = 2820) on the Hearing Handicap Inventory for the Elderly–Screening to detect moderate hearing loss (>40 dB), pooled sensitivity was 68% (95% CI, 52%-81%) and pooled specificity was 78% (95% CI, 67%-86%). Six trials (n = 853) evaluated amplification vs control in populations with screen-detected or recently detected hearing loss over 6 weeks to 4 months. Five measured hearing-related function via the Hearing Handicap Inventory for the Elderly; only 3 that enrolled veterans (n = 684) found a significant difference considered to represent a minimal important difference (>18.7 points). Few trials reported on other eligible outcomes, and no studies reported on harms of screening or interventions. CONCLUSIONS AND RELEVANCE: Several screening tests can adequately detect hearing loss in older adults; no studies reported on